Understanding Disparities in HIV Infection Between Black and White MSM in the United States

The investigators sought to evaluate several hypotheses for HIV infection disparities between white and black men who have sex with men, including incarceration, partner HIV status, circumcision, sexual networks, and duration of infectiousness. The study design incorporated the 2008 National HIV Behavioral Surveillance System, a cross-sectional survey performed in 21 U.S. cities.

MSM were interviewed and tested for HIV. For previously undiagnosed MSM, logistic regression was used to test associations between newly diagnosed HIV and incarceration history, partner HIV status, circumcision status, and sexual networks (oldest partners, concurrency and partner risk behaviors). For HIV-positive MSM, factors related to duration of infectiousness were assessed.

Among 5,183 previously undiagnosed MSM, incarceration history, circumcision status, and sexual networks were not independently associated with HIV infection. Infection was associated with having HIV-positive partners (adjusted odds ratio=1.9, 95 percent confidence interval=1.2-3.0) or partners of unknown status (AOR=1.4, CI=1.1-1.7). "Of these two factors, only one was more common among black MSM -- having partners of unknown HIV status. Among previously diagnosed HIV-positive MSM, black MSM were less likely to be on antiretroviral therapy (ART)," the authors wrote.

HIV infection differences between black and white MSM may partly be explained by less knowledge of partner HIV status and lower ART use among black MSM, the investigators concluded. "Efforts to encourage discussions about HIV status between MSM and their partners and decrease barriers to ART provision among black MSM may decrease transmission," they noted.

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